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Trumpcare- Passed the House and onto the Senate; will it pass there? And what will it finally look like? (1 Viewer)

The Commish said:
Right...this is what I am refuting and replacing with what happened.  Your second paragraph says exactly what I said when it came to the GOP.  The reality is, Obama's original proposal had a public option in it.  That was axed in the Senate before it even got to the GOP in the House because the Senate deemed the public option a non-starter politically.

So this:

is demonstrably incorrect.  It was in his original plan and the Senate told him "no". Ben Nelson (D) specifically as well as Joe Lieberman (technically an "independent")
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An uncommon thing to do here, but after doing more reading, I'll admit you're right on the details about what killed the public option.  Lieberman had a big hand in axing the public option.

However, my broader point was that the Obama administration did start out the negotiations using a conservative framework in order to get Republican support.  He was criticised roundly in his negotiations for starting out at a position of compromise.  We dont' know what a bill that would've been founded on more liberal ideas might or might not have done because it didn't happen, but based on Lieberman's opposition to the public option it might have been in trouble...however, we just don't know if compromises could've been made there to get his vote.

If we go back to my main point you said "THe GOP was exactly none of the equation" and I still maintain that the original central starting point of the ACA was based on a conservative framework in order to try to get support from Republicans.  They were unable to append a public option onto that conservative framework, but that still doesn't take away from the fact that the GOP was definitely part of why Obama chose that framework to begin with.

 
matttyl said:
adonis said:
It would be interesting to get a breakdown of this data by experts...
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It's pretty readily available. 

Anyway my point is that there were 55m enrolled in Medicaid in 2013, today there are 74.2m enrolled (well, as of December 2016).  That's about 19m more people. 

Yes, some folks were previously either excluded or priced out of the individual market and no longer are - but with the spike in prices for individual policies that followed to allow that, many previously insured folks are now priced out (not everyone is eligible for subsidies).  While the numbers are a bit all over the place, I personally think that about 11-12m people had individual coverage pre-ACA, possibly a wee bit more.  Today that number is higher, but only to about 14-15m after the big price increases last year.  These "20 million new insured" aren't covered via private policies - the vast majority were simply put on Medicaid.
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Yeah, I mean that's good information.  Seems like you're adding some clarity to my purposefully general comment about more people being insured today than before Obamacare (which, to be fair, was in reply to your comment focused mainly on commercial insurance).  

However, my main point was that despite the problems in the marketplace with premiums, the issue is that there are tons more insured today than there were before...and addressing that issue in a way that doesn't drop people off plans is a very difficult endeavor for republicans and for any alternative to the ACA.  

I posted a list of criteria that are floating around washington based on leaks of the republican "plans" (in quotes because none are complete plans yet), but even those will have a pretty significant disruption to the total number of insured.

To me, hearing Republicans talk about this issue it seems that they are prioritizing costs over # insured.  They'll focus on solutions geared towards giving chunks of cash to pay for people's care, and if that ends up being too little, folks will get dropped and that's fine for those proposing this solution.  Same thing with other elements of the plan such as the high risk pool being given too little funding to adequately meet those needs.

We have two factions that want different things and it's hard to see where compromise, a dirty word these days, comes up:

- One side wants all folks to be able to be insured regardless of income.

- The other side wants to keep costs down and doesn't have a problem with folks not being able to be insured based on income.

 
Is this where we talk about the House GOP putting their draft Obamacare replacement bill under lock and key and refusing to allow anyone to see it while also scheduling a vote that will likely take place before the CBO scores it?

I like this photo of Rand Paul being denied entry to the room where they're keeping the bill.

 
adonis said:
The Commish said:
Right...this is what I am refuting and replacing with what happened.  Your second paragraph says exactly what I said when it came to the GOP.  The reality is, Obama's original proposal had a public option in it.  That was axed in the Senate before it even got to the GOP in the House because the Senate deemed the public option a non-starter politically.

So this:

is demonstrably incorrect.  It was in his original plan and the Senate told him "no". Ben Nelson (D) specifically as well as Joe Lieberman (technically an "independent")
Click to expand...
An uncommon thing to do here, but after doing more reading, I'll admit you're right on the details about what killed the public option.  Lieberman had a big hand in axing the public option.

However, my broader point was that the Obama administration did start out the negotiations using a conservative framework in order to get Republican support.  He was criticised roundly in his negotiations for starting out at a position of compromise.  We dont' know what a bill that would've been founded on more liberal ideas might or might not have done because it didn't happen, but based on Lieberman's opposition to the public option it might have been in trouble...however, we just don't know if compromises could've been made there to get his vote.

If we go back to my main point you said "THe GOP was exactly none of the equation" and I still maintain that the original central starting point of the ACA was based on a conservative framework in order to try to get support from Republicans.  They were unable to append a public option onto that conservative framework, but that still doesn't take away from the fact that the GOP was definitely part of why Obama chose that framework to begin with.
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In the history of healthcare reform, the sticking points were, and still are, the funding mechanism and the public option.  The rest, they generally agreed on (even though today the GOP will say this isn't true once Obama put into motion his plan).  I'm not sure labeling all that is "conservative" is quite accurate.  Those things were bipartisan.  So, Obama's plan was essentially:  everything that had been agreed on in the past by both parties + a flavor of how the dems wanted to fund it (instead of how the GOP wanted to fund it) + the public option.

If this is what you mean by "conservative framework", then we agree.  It's not the first thing that comes to my mind when I hear that phrase though.

 
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TobiasFunke said:
Is this where we talk about the House GOP putting their draft Obamacare replacement bill under lock and key and refusing to allow anyone to see it while also scheduling a vote that will likely take place before the CBO scores it?

I like this photo of Rand Paul being denied entry to the room where they're keeping the bill.
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So pathetically sad :lmao:  

 
Henry Ford said:
They absolutely have incentive to lower the cost - the lower the cost the more different things you have to pay for out of your deductible before they pay a penny and the less they spend on care.  

But exactly - you got a bill for $6,000 from the provider, no doubt your insurer actually paid $2,000-3,000, and even if you had to pay that out of pocket for deductible, you'd be getting a $3,000-4,000 benefit out of having insurance. Which is huge. 
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If there was an incentive to keep costs down we wouldn't see them climbing as rapidly as they are. Doctors/hospitals want to make a profit, insurance companies want to make a profit, and that relationship has to be in place before the employer/customer purchases insurance. Many of us effectively consider health insurance an inelastic service and will pay whatever we can afford to keep it. So, we have costs that are hidden to us, being negotiated by others, that we then are on the hook for.

The benefit of 3000-4000 is real - but *only* because we don't know what our insurance company pays out for that particular service. Doctor's/hospitals overcharge insurance to get a fraction of the payout. I also think I see why we disagreed on the whole uninsured/insured cost. A doctor might bill $500 for a 10 minute office visit... but he is only expecting to receive a fraction of that. If you are uninsured and *don't* negotiate a cash price ahead of time, you will be billed (and on the hook) for that $500. With insurance you pay your co-pay/deductible and the insurance company pays what it thinks the service is worth based on either a previously negotiated rate or based on some algorithm it uses.

 
sn0mm1s said:
If there was an incentive to keep costs down we wouldn't see them climbing as rapidly as they are. Doctors/hospitals want to make a profit, insurance companies want to make a profit, and that relationship has to be in place before the employer/customer purchases insurance. Many of us effectively consider health insurance an inelastic service and will pay whatever we can afford to keep it. So, we have costs that are hidden to us, being negotiated by others, that we then are on the hook for.

The benefit of 3000-4000 is real - but *only* because we don't know what our insurance company pays out for that particular service. Doctor's/hospitals overcharge insurance to get a fraction of the payout. I also think I see why we disagreed on the whole uninsured/insured cost. A doctor might bill $500 for a 10 minute office visit... but he is only expecting to receive a fraction of that. If you are uninsured and *don't* negotiate a cash price ahead of time, you will be billed (and on the hook) for that $500. With insurance you pay your co-pay/deductible and the insurance company pays what it thinks the service is worth based on either a previously negotiated rate or based on some algorithm it uses.
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We know exactly what the insurance company pays out.  Look at your benefits statements. Or do you mean we don't know what the insurance company pays to negotiate?

 
Henry Ford said:
We know exactly what the insurance company pays out.  Look at your benefits statements. Or do you mean we don't know what the insurance company pays to negotiate?
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You know *after the fact*. For many services, you have no idea what the doctor is going to bill your insurance nor do you know what your insurance company is going to pay the doctor if you asked the receptionist, "How much is this going to cost?" prior to receiving said service.

 
sn0mm1s said:
You know *after the fact*. For many services, you have no idea what the doctor is going to bill your insurance nor do you know what your insurance company is going to pay the doctor if you asked the receptionist, "How much is this going to cost?" prior to receiving said service.
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Oh, gotcha.  Yeah, you sometimes can for certain things - tell them you don't know if you've met your deductible yet and you may have to pay cash, and they can tell you total price.  And they'll want you to pay your amount up front otherwise, usually.  So deduct your copay from the total - Voila!

 
TobiasFunke said:
Is this where we talk about the House GOP putting their draft Obamacare replacement bill under lock and key and refusing to allow anyone to see it while also scheduling a vote that will likely take place before the CBO scores it?

I like this photo of Rand Paul being denied entry to the room where they're keeping the bill.
Click to expand...
That is how government operates.  Pelosi said "Pass the bill to find out what is in it"  Nothing changes.  It all stinks..but if the cost comes down I guess that is what matters to most.

 
Da Guru said:
That is how government operates.  Pelosi said "Pass the bill to find out what is in it"  Nothing changes.  It all stinks..but if the cost comes down I guess that is what matters to most.
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It's not, at all. Trust me, I know.

Also the Pelosi quote was out of context- she clearly meant to imply that the public was being made aware of the negatives of the legislation by its opponents but that the positives would become more apparent after the law went into effect.  That's explained here.  And if you've been paying attention to recent polling and town hall activity you'd know that she was actually kinda right.

 
Henry Ford said:
Oh, gotcha.  Yeah, you sometimes can for certain things - tell them you don't know if you've met your deductible yet and you may have to pay cash, and they can tell you total price.  And they'll want you to pay your amount up front otherwise, usually.  So deduct your copay from the total - Voila!
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Right, in some cases you can do that. In some cases, you can negotiate a cash price which is significantly less than what the insurance would pay out. However, if you already have insurance your copay is almost always going to the less than a negotiated cash price. This might seem like a deal - but obviously isn't. Doctor's can't make huge profits along with insurance companies making huge profits, if the current system of premium/copay/deductible is all that great for the consumer.

 
sn0mm1s said:
Right, in some cases you can do that. In some cases, you can negotiate a cash price which is significantly less than what the insurance would pay out. However, if you already have insurance your copay is almost always going to the less than a negotiated cash price. This might seem like a deal - but obviously isn't. Doctor's can't make huge profits along with insurance companies making huge profits, if the current system of premium/copay/deductible is all that great for the consumer.
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What world do you live in that doctors make huge profits?  The average salary for a primary care physician is like $200k.  Insurance companies don't typically make a huge profit either and neither do the vast vast majority of hospitals. 

The only healthcare providers making good profits are the Rx and device companies.  Good Rx and device salesmen/women laugh at $200k.  Imagine how much the company is raking in from their sales.

 
urbanhack said:
https://theintercept.com/2016/08/27/obamacares-faltering-for-one-simple-reason-profit/
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This is true, but I think the costs we wonder about is how come the rubber gloves in the dispenser on the hospital wing floor wind up costing $90 a piece for the same gloves we can get in the hardware store for a buck? Hyperbole a bit to make the point, but these types of costs, like this and the regular outpatient procedures that are happen thousands of times a day that are like $10K-20K a piece, it adds up to crazy numbers. Where's the economy of scale in purchasing, or the cost per use efficiencies of these medical devices? It's crazy.

 
TobiasFunke said:
It's not, at all. Trust me, I know.

Also the Pelosi quote was out of context- she clearly meant to imply that the public was being made aware of the negatives of the legislation by its opponents but that the positives would become more apparent after the law went into effect.  That's explained here.  And if you've been paying attention to recent polling and town hall activity you'd know that she was actually kinda right.
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LMAO

 
I'm bumping this thread because reports are that Trump's plan on this will be released this week. Once we have the details, then we can discuss how this is all going to work...

 
timschochet said:
Tax credits for poor people.
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Isn't it the age based credits for everyone buying their own insurance? From a CNN article it looks like there is just some income max which I assume will be above middle class income.

Edit: Wow, the article you linked says they can be up to $14K.

 
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Juxtatarot said:
Isn't it the age based credits for everyone buying their own insurance? From a CNN article it looks like there is just some income max which I assume will be above middle class income.

Edit: Wow, the article you linked says they can be up to $14K.
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That's a big deal. But the biggest deal is that insurance companies aren't allowed to charge more for pre-existing conditions. How can this be paid for without a mandate? I see chaos ahead. 

 
Phase of the Game said:
Like a lot of us predicted when Obamacare was passed and were laughed at by you and others?
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I don't think you're referrring to me. I saw chaos then too. I was against Obamacare from the start, mostly because I believed that the mandate would never come close to paying for the pre-existing conditions. 

But this is worse. At least the mandate paid for SOME of it. Here they're paying for none of it. This is a magic plan. 

 
timschochet said:
That's a big deal. But the biggest deal is that insurance companies aren't allowed to charge more for pre-existing conditions. How can this be paid for without a mandate? I see chaos ahead. 
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This Reuters article has this on the tax credits:

In the most recent version of the bill, the tax credits would only be available to those within certain income levels, according to Politico. They would start to phase out for individuals earning $75,000 and households earning $150,000, and would be unavailable for individuals who earn more than $215,000, Politico reported.
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I mentioned this before but I think there now is an incentive for companies to drop health care coverage for employees, increase their employees' pay, and tell them to get insurance on their own while taking advantage of the tax credits.

 
ACA - Now with more H !!!!!

ACA - now with New and Improved H !!!!!

ACA - now in the new H size!!!

 
timschochet said:
I don't think you're referrring to me. I saw chaos then too. I was against Obamacare from the start, mostly because I believed that the mandate would never come close to paying for the pre-existing conditions. 

But this is worse. At least the mandate paid for SOME of it. Here they're paying for none of it. This is a magic plan. 
Click to expand...
How did the mandate even pay for SOME of it when the mandate wasn't being enforced?

 
timschochet said:
Because a lot of people obey laws without any punishment, that's why. 

But why are you still focused on this? Do you not see the flaws of this new plan? 
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I haven't even read he new plan.  Working and all that stuff.

Besides, why not just give the GOP a pass and wait until it's passed before rendering judgement?  It worked in 2009 why can't it work now?

 
The individual and employer mandates are eliminated. They’re not repealed exactly, but the penalties are repealed, which amounts to the same thing. ( not awful for anyone who cares about individual freedom and liberty )

 Without a requirement that individuals carry health insurance, the insurance markets are almost certain to collapse.(not awful for leftists which if this happens certainly will bring universal health care )

 
We need to pass a law that no bill Canberra passed that doesn't result in at least breaking even per the CBO

 
What gets me is that 9 years after we started this country is still fighting over health care. 

9 years.

The GOP will pass its revision without Dem input, just as the Dems passed theirs without GOP input.

The Dems will spend 2-10 years ramping up its fundraising and agitation to oppose the new law, just as the GOP did.

The cost of HC will go up for many, and they will burden the cost of others, and the GOP will not be frank about that.

On & on we go. We need a consensus law, but like immigration this appears impossible to arrive at no matter how bad it gets.

 
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SaintsInDome2006 said:
What gets me is that 9 years after we started this country is still fighting over health care. 

9 years.

The GOP will pass its revision without Dem input, just as the Dems passed theirs without GOP input.

The Dems will spend 2-10 years ramping up its fundraising and agitation to oppose the new law, just as the GOP did.

The cost of HC will go up for many, and they will burden the cost of others, and the GOP will not be frank about that.

On & on we go. We need a consensus law, but like immigration this appears impossible to arrive at no matter how bad it gets.
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The GOP version seems very similar to the ACA, so I'm baffled by all #####ing and moaning over it the past 8 years.  Defunding Planned Parenthood is a terrible idea, but relatively insignificant.  What either side does is moot unless we can address the actual healthcare costs.  So far I am fairly happy with the GOP proposal, but don't understand how it will reduce premiums.  Seems like it will have the opposite effect.

 
timschochet said:
Phase of the Game said:
Like a lot of us predicted when Obamacare was passed and were laughed at by you and others?
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I don't think you're referrring to me. I saw chaos then too. I was against Obamacare from the start, mostly because I believed that the mandate would never come close to paying for the pre-existing conditions. 

But this is worse. At least the mandate paid for SOME of it. Here they're paying for none of it. This is a magic plan. 
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Not really Tim.  The mandate could ONLY be collected via taxes.  If you didn't get a refund, there was no real way for them to collect.  The notion that Obamacare at least paid for some of it is another way of lowering the bar of expectation.

Does it surprise anyone that the GOP doesn't get it either?  No significant addressing of bottom line costs is a nonstarter.  This is going to be a turd just like Obamacare.  In the end, they really aren't all that different.  The funding mechanism is different....that's really the one significant change that I've seen so far.

 
Dr Oadi said:
The individual and employer mandates are eliminated. They’re not repealed exactly, but the penalties are repealed, which amounts to the same thing. ( not awful for anyone who cares about individual freedom and liberty )

 Without a requirement that individuals carry health insurance, the insurance markets are almost certain to collapse.(not awful for leftists which if this happens certainly will bring universal health care )
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To the underlined - why?  We never had any mandates in the health insurance markets from the time health insurance was a thing until 2014 - the markets didn't collapse then.  Why would they now?

 
Dickies said:
but don't understand how it will reduce premiums.  Seems like it will have the opposite effect.
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While it won't work, their idea is to have "high risk pools."  I think the stat is something like the top 5% of a health insurance pool carry 50% of the cost.  If you can exclude that 5% from the pool (and instead have them in a high risk pool), then the cost of insuring the other 95% will be half.  Pre-ACA, via underwriting, carriers got pretty good at determining who that 5% was going to be, which was why premiums (in the individual market) were so much lower then on average. 

 
matttyl said:
While it won't work, their idea is to have "high risk pools."  I think the stat is something like the top 5% of a health insurance pool carry 50% of the cost.  If you can exclude that 5% from the pool (and instead have them in a high risk pool), then the cost of insuring the other 95% will be half.  Pre-ACA, via underwriting, carriers got pretty good at determining who that 5% was going to be, which was why premiums (in the individual market) were so much lower then on average. 
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Forgive my ignorance- what then happens to the people in the high risk pool?  Are they subsidized or are the premiums just impossibly high for them?

Thanks, I was looking forward to your thoughts on this bill. 

 
Dr Oadi said:
The individual and employer mandates are eliminated. They’re not repealed exactly, but the penalties are repealed, which amounts to the same thing. ( not awful for anyone who cares about individual freedom and liberty )

 Without a requirement that individuals carry health insurance, the insurance markets are almost certain to collapse.(not awful for leftists which if this happens certainly will bring universal health care )
Click to expand...
Will bring about universal healthcare? You think when it collapses the GOP is going to suddenly say "whelp, never mind, let's go Medicare For All."

 
TobiasFunke said:
Forgive my ignorance- what then happens to the people in the high risk pool?  Are they subsidized or are the premiums just impossibly high for them?

Thanks, I was looking forward to your thoughts on this bill. 
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There is (I believe) $100B allocated for these high risk pools in this bill.  That money, though, is for a 10 year period and may not be enough to cover the entirety of the first two years of the pools.  These individuals will still have premiums of their own, though.  (For what it's worth, the current ACA individual pools are slowly turning into high risk pools themselves, so something has to be done - I'm just not sure this is what's needed).

Still looking though this proposal - and trying to find a decent source on it that's not extremely biased one way or the other.

 
Henry Ford said:
Will bring about universal healthcare? You think when it collapses the GOP is going to suddenly say "whelp, never mind, let's go Medicare For All."
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Again, why would it collapse?  No health insurance market ever had a mandate until 2014, and we didn't see collapse then.  So why would we now?  I mean, we're seeing collapse in the current individual ACA market, but that has (or at least has had) a mandate. 

 
matttyl said:
There is (I believe) $100B allocated for these high risk pools in this bill.  That money, though, is for a 10 year period and may not be enough to cover the entirety of the first two years of the pools.  These individuals will still have premiums of their own, though.  (For what it's worth, the current ACA individual pools are slowly turning into high risk pools themselves, so something has to be done - I'm just not sure this is what's needed).

Still looking though this proposal - and trying to find a decent source on it that's not extremely biased one way or the other.
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Thanks. 

If you want to go straight to the source there are links to the bill itself and to a Committee-produced summary towards the bottom of the page here.  The latter is obviously a biased source but it's still a fairly dry, facts-only recitation.

 
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